HomeMy WebLinkAbout4349 KINGSBURY DR - SPECIAL INSPECTIONS - 11/18/2015City of Community Development & Neighborhood Services
F^r} Collins 281 N College Ave; P.O. Box 0 22 Fort Collins, CO 80522-0580
6134
� ` Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form
Job Site A3 P Permit No. 9(92ZI5 3
Company Name A) City of Ft Collins Lic#
Replacement of Sewer line approx. ft. (100 ft. maximum) FC) ] B 1 6
Replacement of Water line approx. ft. (100 ft. maximum)
_ Add Replace gas line approx. —b ft. ( 50 ft. maximum)
Materials used: (-��
Tested at Lbs. for —C minutes
Installer Name (print)
Installer Signature Date IT��gi� �`'